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Background: Patients (pts) with thoracic cancers have a high rate of hospitalization and death from COVID-19. Smoking has been associated with increased risk for severe COVID-19. However, there is limited data evaluating the impact of smoking recency on COVID-19 severity in pts with cancer. We aimed to characterize the clinical outcomes of COVID-19 based on the recency of smoking in pts with thoracic cancers (TC) and all other cancers (OC). Methods: Adult pts with cancer and lab-confirmed SARS-CoV-2 and smoking history recorded in the CCC19 registry (NCT0435470) were included. Pts were stratified by cancer type (TC or OC) and further stratified into subgroups based on the recency of smoking cessation: current smoker;former smokers who quit < 1 yr. ago;1-5 yr. ago;6-10 yr. ago;quit > 10 yr. ago;and never smoker. 30-day all-cause mortality was the primary endpoint. Secondary endpoints were any hospitalization;hospitalization with supplemental O2;ICU admission;and mechanical ventilation. Results: From January 2020 to December 2021, 752 pts from TC group and 8,291 pts from OC group met the inclusion criteria. 78% of patients in TC group ever smoked compared to 36% patients in the OC group. In both groups, the majority of never-smokers were females (70% and 60% in TC and OC respectively). The burden of smoking and the rate of pulmonary comorbidities (PC) was higher in the TC group (PC 22-69%) compared to OC group (PC 12-26%) across all smoking strata. Overall, 30-day all-cause mortality was 21% and 11% in pts with TC and OC respectively. Former smokers who quit < 1 year ago in TC group had the highest rate of mortality and severe COVID-19 outcomes. However, in the OC group, there was no consistent trend of higher mortality or severe COVID-19 outcomes in specific subgroups based on smoking recency. Conclusions: To our knowledge this is the largest study evaluating the effect of granular phenotypes of smoking recency on COVID-19 outcomes in pts with cancer. Recent smokers who quit < 1 year ago in TC group had the highest rate of mortality and severe COVID-19. Further analysis exploring the factors (e.g., smoking pack years) associated with severe outcomes in this subgroup is planned.
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Rationale Multiple anecdotal reports describe patients with COVID-19 presenting with what is referred to as silent hypoxemia (without dyspnea, tachypnea, or respiratory distress). However, there is a paucity of literature on this problem. We conducted a study to determine the prevalence of silent hypoxemia in patients with COVID-19 infection at presentation in the emergency department (ED) or on admission, and compared it with that of patients with pneumonia by any other etiology at Memorial Hermann Health System. In addition, we analyzed the differences between clinical, laboratory, hospital utilization, and mortality. Methods From electronic medical records, we identified pneumonia patients with a positive result for coronavirus on reverse transcriptasepolymerase chain reaction (RT-PCR) nasopharyngeal swab test, or diagnosis of pneumonia by influenza or any other etiology for one year, presenting to the ED or admitted to any MHHS hospital. We extracted age, sex, race/ethnicity, vital signs, oxygen saturation, intensive care unit (ICU) admission, and hospital stay for all patients. Results A total of 17,475 COVID-19 patients were compared with 2,343 patients with influenza/pneumonia of any etiology. The two groups were similar with respect to age, sex, and ethnicity. The frequency of silent hypoxemia was greater in the COVID-19 (n=232, 1.3%) group compared to influenza/pneumonia (n= 3, 0.13%) patients (p<0.001). For patients with an oxygen saturation < 90, the proportion who had silent hypoxemia was 11.7% (232/1981) in the COVID-19 patients and 2.6% (3/117) in the influenza and other viral pneumonia patients. Between COVID-19 patients admitted to the hospital, patients with symptomatic hypoxemia had a longer hospital stays (median: 11 days, IQR: 6-22) compared to those with silent hypoxemia (median: 8 days, IQR: 4-18) (p=0.001). The symptomatic hypoxemia group was more likely to be admitted to the ICU (n=457, 26.1%) compared to the silent hypoxemic patients (n=33, 15.5%) (p<0.001) and the mortality rate was higher (n=454, 26.0%) vs (36, 15.5%) (p=0.001). Conclusion The prevalence of silent hypoxemia for adults with viral pneumonia who were seen in the ED or hospitalized in a 17- hospital system in Houston, was higher in the COVID-19 infection patient group compared to patients with other pneumonias or any other etiology. Among the COVID-19 subjects, those with symptomatic hypoxemia had worse outcomes compared to those with silent hypoxemia. More studies are needed to confirm these findings.
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BACKGROUND: Many patients with coronavirus disease 2019 (COVID-19) have been diagnosed with computed tomography (CT). A prognostic tool based on CT findings could be useful for predicting death from COVID-19. OBJECTIVES: To compare the chest CT findings of patients who survived COVID-19 versus those of patients who died of COVID-19 and to determine the usefulness the clinical usefulness of a CT scoring system for COVID-19. METHODS: We included 124 patients with confirmed SARS-CoV-2 infections who were hospitalized between April 1, 2020 and July 25, 2020. RESULTS: Whereas ground-glass opacities were the most common characteristic finding in survivors (75%), crazy paving was the most characteristic finding in non-survivors (65%). Atypical findings were present in 46% of patients. The chest CT score was directly proportional to mortality; a score ≥18 was the best cutoff for predicting death, yielding 70% sensitivity (95%CI: 47%-87%). CONCLUSIONS: Our results suggest that atypical lesions are more prevalent in this cohort. The chest CT score had high sensitivity for predicting hospital mortality.
Subject(s)
COVID-19 , Humans , Lung , SARS-CoV-2 , Survivors , Tomography, X-Ray Computed/methodsABSTRACT
Background Many patients with coronavirus disease 2019 (COVID-19) have been diagnosed with computed tomography (CT). A prognostic tool based on CT findings could be useful for predicting death from COVID-19. Objectives To compare the chest CT findings of patients who survived COVID-19 versus those of patients who died of COVID-19 and to determine the usefulness the clinical usefulness of a CT scoring system for COVID-19. Methods We included 124 patients with confirmed SARS-CoV-2 infections who were hospitalized between April 1, 2020 and July 25, 2020. Results Whereas ground-glass opacities were the most common characteristic finding in survivors (75%), crazy paving was the most characteristic finding in non-survivors (65%). Atypical findings were present in 46% of patients. The chest CT score was directly proportional to mortality;a score ≥18 was the best cutoff for predicting death, yielding 70% sensitivity (95%CI: 47%–87%). Conclusions Our results suggest that atypical lesions are more prevalent in this cohort. The chest CT score had high sensitivity for predicting hospital mortality.
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Background: Many patients with coronavirus disease 2019 (COVID-19) have been diagnosed with computed tomography (CT). A prognostic tool based on CT findings could be useful for predicting death from COVID-19. Objectives: To compare the chest CT findings of patients who survived COVID-19 versus those of patients who died of COVID-19 and to determine the usefulness the clinical usefulness of a CT scoring system for COVID-19. Methods: We included 124 patients with confirmed SARS-CoV-2 infections who were hospitalized between April 1, 2020 and July 25, 2020. Results: Whereas ground-glass opacities were the most common characteristic finding in survivors (75%), crazy paving was the most characteristic finding in non-survivors (65%). Atypical findings were present in 46% of patients. The chest CT score was directly proportional to mortality; a score ≥ 18 was the best cutoff for predicting death, yielding 70% sensitivity (95%CI: 47%-87%). Conclusions: Our results suggest that atypical lesions are more prevalent in this cohort. The chest CT score had high sensitivity for predicting hospital mortality.
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Background: Currently, there are no biomarkers to predict respiratory worsening in patients with Coronavirus infectious disease, 2019 (COVID-19) pneumonia. Objectives: We aimed to determine the prognostic value of Krebs von De Lungen-6 circulating serum levels (sKL-6) predicting COVID-19 evolving trends. Methods: We prospectively analyzed the clinical and laboratory characteristics of 375 COVID-19 patients with mild lung disease on admission. sKL-6 was obtained in all patients at baseline and compared among patients with respiratory worsening. Results: 45.1% of patients developed respiratory worsening during hospitalization. Baseline sKL-6 levels were higher in patients who had respiratory worsening (median [IQR] 303 [209-449] vs. 285.5 [15.8-5724], P=0.068). The best sKL-6 cut-off point was 408 U/mL (area under the curve 0.55;33% sensitivity, 79% specificity). Independent predictors of respiratory worsening were sKL-6 serum levels, age >51 years, time hospitalized, and dyspnea on admission. Patients with baseline sKL-6 ≥ 408 U/mL had a 39% higher risk of developing respiratory aggravation seven days after admission. In patients with serial determinations, sKL-6 was also higher in those who subsequently worsened (median [IQR] 330 [219-460] vs 290.5 [193-396];p<0.02). Conclusion: sKL-6 has a low sensibility to predict respiratory worsening in patients with mild COVID-19 pneumonia. Baseline sKL-6 ≥ 408 U/mL is associated to a higher risk of respiratory worsening. sKL-6 levels are not useful as a screening tool to stratify patients on admission but further research is needed to investigate if serial determinations of sKL-6 may be of prognostic use.
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Introduction: The SARS-CoV-2 coronavirus is a new pathogen causing COVID-19 disease, ranging from an asymptomatic infection to a critical condition dependent on mechanical ventilation. Rehabilitation interventions contribute for the prevention and treatment of related complications and associated disability. Objectives: Describe rehabilitation recommendations for adult patients with COVID-19. Methods: A literature search was carried out. Databases and portals were consulted using the following terms and their equivalents: SARS-CoV2, COVID-19, rehabilitation, physiotherapy. The search was carried out in Spanish, English, Chinese and Italian languages, with a time window between January 2010 and April 2020. Results: 23 publications met the predetermined inclusion and exclusion criteria. Based on the information obtained, recommendations and tables were prepared about the clinical classification of COVID-19, medical behavior to be followed according to severity, general care and rehabilitation interventions in adult patients with COVID-19. Conclusions: Rehabilitation interventions are essential and indispensable resources for the multidisciplinary treatment of patients with COVID-19, despite of the low quality of the available evidence.